Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 178069 | OR |
NPI | 1003166612 |
---|---|
Provider Name | Dr. Matthew Raymond Lilley |
First Address | Bend, OR 97701-4281 |
Second Address | Bend, OR 97701-4281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122323 | CALIFORNIA MEDICAL BOARD (01) | CA |
178069 | OREGON MEDICAL BOARD (01) | OR |
500730702 | (05) | OR |
60659856 | WASHINGTON MEDICAL BOARD (01) | WA |